The annual meeting of the American Orthopaedic Society for Sports Medicine was held from July 7 to 10 in San Diego and attracted approximately 1,300 participants from around the world, including sports medicine specialists, athletic trainers, physical therapists, and family physicians. The conference featured the latest advances in sports medicine, with presentations focusing on the identification, prevention, treatment, and rehabilitation of sports injuries.
In one study, Timothy A. McGuine, Ph.D., of the University of Wisconsin-Madison, and colleagues found that lace-up ankle braces reduced the incidence of acute ankle injuries among high school basketball players. The investigators randomized 1,460 male and female basketball players, between the ages of 13 and 18 years, to a braced group, who wore a synthetic, fabric, lace-up ankle brace, or a control group with no brace.
"We found that lace-up ankle braces reduced the incidence of acute ankle injuries. The data revealed that students in the control group, who did not wear lace-up ankle braces, were three times more likely to incur ankle injuries as compared to those who wore lace-up ankle braces," McGuine said. "However, we also found that wearing the ankle brace did not reduce acute ankle injury severity."
Yet, according to McGuine, the incidence and severity of knee injuries were not different among those who wore the lace-up ankle brace as compared to those who did not.
"Widespread use of lace-up ankle braces has the potential to significantly reduce the number of injuries in these athletes and save millions of health care dollars currently spent to treat them," McGuine said.
In another study, Bob Magnussen, M.D., of Duke Sports Medicine in Durham, N.C., and colleagues found that decreased hamstring autograft size and decreased patient age were predictors of early graft revision among patients who underwent anterior cruciate ligament (ACL) reconstruction. The investigators evaluated 256 patients who underwent ACL reconstruction with hamstring autograft to assess the effect of graft size, patient age, and gender on revision rates.
"Use of hamstring autografts 8 mm in diameter or less in patients under age 20 was associated with relatively high revision rates," Magnussen said.
According to Magnussen, revision ACL reconstruction was performed in 18 of 256 patients (7.0 percent) at a mean of 12 months following surgery. Revision was performed in one of 58 patients (1.7 percent) with grafts greater than 8 mm in diameter, nine of 139 patients (6.5 percent) with 7.5 or 8 mm grafts, and eight of 59 patients (13.6 percent) with grafts 7 mm or less in diameter (P = 0.049). One revision was performed in the 137 patients age 20 and older (0.7 percent); however, 17 revisions were performed in the 119 patients under 20 (14.3 percent) (P < 0.0001).
"ACL graft size has received less attention than other factors such as patient age, graft type (allograft versus autograft, hamstring versus patellar tendon), and surgical technique. While this study is far from definitive, we hope it encourages other investigators to include this variable in future studies to further clarify any relationship between graft size and revision rate," Magnussen said. "Further confirmation of these results may lead to the avoidance of small ACL hamstring grafts in young active patients."
In another study, Tinker Gray, of the Shelbourne Knee Center in Indianapolis, and colleagues found that the incidence of osteoarthritis on radiographs in the long-term after ACL reconstruction was lower when patients achieved and maintained normal knee range of motion. The investigators evaluated 780 patients several years after ACL reconstruction to determine how rehabilitation to achieve normal knee range of motion might affect the incidence of arthritic changes observed on radiographs.
"Of patients who achieved normal knee range of motion, 71 percent had normal radiographs. This compares to only 55 percent with normal radiographs in patients who had knee range of motion deficits," Gray said. "Future studies looking at factors related to osteoarthritis in the long-term outcome of ACL reconstruction should include a critical evaluation of knee range of motion."
Diane L. Dahm, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues found that patients with a history of cancer were at a higher risk for developing venous thromboembolic events (VTEs) such as pulmonary embolism (PE) or deep vein thromboses (DVT) following knee arthroscopy. The investigators evaluated data on 12,595 patients who underwent knee arthroscopy between 1985 and 2005.
The incidence of symptomatic DVT and PE was 0.3 and 0.06 percent, respectively. Risk factors for the development of a VTE included cancer, prior VTE history, and history of two or more other risk factors, including age greater than 65, body mass index greater than 30 kg/m², use of oral contraceptives or hormone replacement therapy, regular use of tobacco, and/or chronic venous insufficiency.
"We do not recommend routine chemoprophylaxis (i.e., oral anticoagulants or subcutaneous heparin) for knee arthroscopy patients, except for those who are deemed high risk," Dahm said. "We recommend that all patients, when possible, should be considered for non-pharmacologic prophylactic measures such as compression stockings, early range of motion, and early mobilization. Future studies should focus on application of these recommendations prospectively to determine the effectiveness of this approach."
Scott Rodeo, M.D., of the Hospital for Special Surgery in New York City, and colleagues found that vitamin D deficiency was associated with an increased risk of muscle injuries among National Football League (NFL) players. The investigators evaluated 89 football players from a single NFL team and performed testing of vitamin D levels in the spring of 2010 during routine pre-season evaluations.
"We found that individuals who sustained a muscle injury had significantly lower vitamin D levels compared to players who did not sustain a muscle injury. This finding should be interpreted with caution, however, as this relationship was based on vitamin D levels drawn in the pre-season, while the muscle injuries occurred later (during the season)," Rodeo said. "Although our data suggest that vitamin D deficiency does occur in athletes and that it may relate to muscle injury, vitamin D supplementation should be approached carefully. There is still controversy as to the vitamin D levels that are optimal for athletic performance."
Rodeo recommends that clinical practitioners directly measure their athletes' vitamin D levels and then supplement only as needed with prescription vitamin D, rather than routine supplementation of all team members.
AOSSM: Gender Tied to Cartilage Lesions in ACL Injury
THURSDAY, July 7 (HealthDay News) -- Males with previous anterior cruciate ligament (ACL) knee injury have an increased risk of full-thickness articular cartilage lesions compared to females, and the risk is increased for those males who received the injury playing team handball, according to a study presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, held from July 7 to 10 in San Diego.
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